Provider Demographics
NPI:1053303818
Name:REILLY, JOHN F (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:F
Last Name:REILLY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2 IVY BROOK RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-6416
Mailing Address - Country:US
Mailing Address - Phone:203-924-2900
Mailing Address - Fax:203-924-1300
Practice Address - Street 1:2 IVY BROOK RD
Practice Address - Street 2:SUITE 105
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-6416
Practice Address - Country:US
Practice Address - Phone:203-924-2900
Practice Address - Fax:203-924-1300
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-18
Last Update Date:2015-01-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT0401662086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
H69471Medicare UPIN